Postoperative adjuvant TXA therapy after surgical evacuation of cSDH was associated with a lower rate of recurrence requiring revision surgery, without an observed increase in mortality; however, the confidence interval marginally crossed unity, and the findings should be regarded as hypothesis-generating.
Revision surgery within 90 days occurred less frequently in the TXA group compared with controls.
Median time to revision surgery differed between the TXA group and the control group.
Mortality was numerically lower in the TXA group compared with controls.
TXA did not significantly influence short-term hematoma volume reduction.
The study used a retrospective single-center design with propensity score matching to compare TXA adjuvant therapy versus surgery alone for chronic subdural hematoma.
The authors characterize chronic subdural hematoma as a common intracranial hemorrhage in elderly patients associated with substantial postoperative recurrence rates.
This research suggests that giving patients the anti-bleeding medication tranexamic acid (TXA) after surgery to drain a chronic subdural hematoma (a type of blood clot that slowly accumulates on the surface of the brain, most commonly in older adults) may reduce the chance of needing a second operation. In this study, about 8% of patients who received TXA after surgery needed a repeat procedure within three months, compared to about 19% of patients who had surgery alone. While this difference was statistically significant, the uncertainty range around the estimate just barely included the possibility of no effect, meaning the result should be treated cautiously. Despite the lower revision rate, TXA did not appear to speed up the actual shrinkage of the blood clot as measured on brain scans — the clot volumes looked similar between the two groups at all time points measured. There were also no deaths in the TXA group compared to one death in the surgery-only group, though this difference was too small to draw firm conclusions. Importantly, no increase in harmful clotting events (such as strokes or blood clots in the legs) was reported in the TXA group, which has been a concern with this type of medication. This research suggests that TXA after surgical drainage of a chronic subdural hematoma may be a promising add-on treatment to help prevent recurrence, but because the study was retrospective (looking back at existing records rather than randomly assigning patients to treatments), the findings are considered preliminary and hypothesis-generating. Larger, randomized controlled trials are needed to confirm whether TXA truly reduces recurrence and to determine the best dose and duration of treatment.
Scheer M, Witte H, Guenzerodt P, Beuchel V, Mauer U, Schulz C. (2026). Revision rate and postoperative volume development of chronic subdural hematomas after burr hole craniotomy in combination with tranexamic acid vs. surgery alone - a single-center propensity score-matched analysis.. BMC neurology. https://doi.org/10.1186/s12883-026-05003-3